Surgical device for expanding collapsed lungs.



. J;S.D EAN. SURGICAL DEVICE FOR EXPANDING- GOLLAPSED LUNGS APPLICATIONFILED JULY 21,190i).

978,708. Patented Dec; 13,1910.

THE NORRIS PETERS cu., wAsHINcrcN, n, ::v

UNITED STATES PATENT OFFICE.

JOHN S. DEAN, OF WHEATLAND, IOWA.

SURGICAL DEVICE FOR EXPANDING COLLAPSED LUNGS.

T0 all whom it may concern:

Be it known that I, JOHN S. DEAN, a citizen of the United States,residing at WVheatland, in the county of Clinton and State of Iowa, haveinvented new and useful Improvements in Surgical Devices for ExpandingCollapsed Lungs, of which the following is a specification.

The present invention is an improvement in surgical devices for thetreatment of collapsed lung, a diseased condition which is due primarilyto the presence of pleural effusions.

lVhen an operation for removal of pleural effusion is performed, asection of rib is first removed, fluid evacuated, and a drainage tubethen inserted. As soon as this has been done, the atmospheric pressureagainst the external surface of the lung, and that introduced internallythereof through the bronchi and trachea will virtually balance.Consequently, the lung that has been collapsed by pressure of thepleural effusion will not expand under normal conditions. In treating acase of this character, it was therefore formerly considered necessaryto apply a heavy dressing to the external wound, thereby partlyexcluding the air from the latter, and to either make use of a WVolfPsbottle or to blow through a constricted tube, so as to forcemoderately-compressed air from the healthy lung into the collapsed lung.Frequently, however, adhesion of the lung to the chest wall took placebefore expansion could be effected, and in such instances, the onlycourse was to resect the ribs and to cave the soft parts of the chest inagainst the collapsed lung.

It is the object of this invention, broadly stated, to produce a deviceby means of which normal respiration may be established immediately uponthe insertion of the drainage tube, thereby insuring prompt expansion bypreventing adhesion.

Further, such object comprehends the production of a device of the abovespecified type in which the drainage tube is. so constructed and soarranged with reference to its support as to provide for its ready andaccurate insertion in the wound irrespective of the angular trend of theincision, and for its retention in position when inserted therein, thusinsuring perfect drainage and at the same time avoiding irritation andmaceration of the tissues consequent upon the tube Specification ofLetters Patent.

Application filed July 21, 1909.

Patented Dec. 13, 1910.

Serial No. 508,744.

becoming displaced; to obviate the necessity for secondary operations ordecortication; to render the patient more comfortable than was possibleunder the old method of treatment; and to materially reduce the timenecessary to obtain a cure.

Finally, the invention contemplates the production of a device which maybe subjected to complete sterilization.

These objects are effected by the present invention, which, brieflydescribed, comprises essentially two members, a support and a drainagetube. The support consists, in turn, of base and wing membersconstructed from a single blank of suitable flexible sheet material, thebase member being provided with a central opening, through which thedrainage tube projects. This tube is pivoted adjacent its lower oroutlet end to the base member, and has a diameter considerably less thanthat of the above mentioned opening, through which it projects, asalready stated. For this reason, the tube is capable of a swingingmovement in a vertical plane, so as to accommodate itself to theangularity of the incision in which it is to be inserted. At its outletend, the tube is provided with a flexible valve. The wing member of thesupport extends in front of and. thus protects the drainage tube.

The preferred embodiment of the invention is illustrated in theaccompanying drawings, wherein:

Figure 1 is a. perspective view of the improved device. Fig. 2 is atransverse vertical "sectional view thereof. Fig. 3 is an enlarged planview of Fig. 1. Figs. 4: and 5 are detail longitudinal sectional viewsof different forms of drainage tubes employed. Fig. 6 is a fragmentalperspective view of the tube shown in Fig. 5, with the valve omitted.

Reference being had to said drawings, and to the characters markedthereon, A denotes in a general manner, the support, and B the drainagetube, of which two elements the device essentially consists.

The support A is constructed from a single die-struck blank of suitablethin sheet metal and comprises a relatively long base member 5, and awing 6, the latter member being formed upon the central portion of theupper edge of the member first-mentioned. Member 5 has a slighttransverse bowing and is provided with a circular opening 7 locatedcentrally thereof. At the edge of this opening, there are formed twodiametrically-opposite perforated lugs '8.

The drainage member B employed in connection with the support is in theform of a short rubber tube of a diameter considerably less than that ofthe opening 7 through which it is designed to project. To support thistube, there is passed through its front or lower end a pin 9, the endsof which project through the perforations in lugs 8. The pin, therefore,serves as the axis upon which the tube swings. It may, as shown, be inthe form of a straight wire strip provided at its ends with heads, oneof which is rem able, or it may be in the form of a safety pin of theordinary type. At its outlet end, the tube carries a valve 10, formed bya disk of oiled silk, which is stitched directly to the upper surface ofsaid end, as indicated by the numeral 11, the stitches passing throughsaid end at a point removed from the face thereof. This valve isnormally in closed position, when the device is in use. There is adefinite and important relation existent between the rapidity of theoperation of the valve and the angle of the lower end face of the tubewith respect to the axis thereof, the valve being designed to close theoutlet end of the tube during inhalation of the patient, and to moveaway from and open said end during exhalation.

It is obvious that the length of the are through which the valve movesduring its closing movement is directly proportional to the timeconsumed in such movement under a constant force. Consequently, as thelength of such are increases, the speed at which the valve moves willdecrease. Assuming, then, that if the outlet end face of the tube formsa right angle with its axis, the valve will close instantly uponinhalation, any rearward beveling of said face will have the effect ofcausing the valve to close more slowly. Therefore, it may be stated thatif said face he oblique rather than perpendicular to the axis of thetube, the degree of such obliqueness will control the rapidity of theoperation of the valve. Tubes in which the principle is embodied areillustrated in Figs. l and 5.

In operations for the removal of pleural effusion, it is consideredadvisable to permit more or less air to enter the pleural cavity atfirst for the purpose of lessening the intra' lung pressure by way ofthe trachea and bronchi, and to gradually reduce the amount of airadmitted, to gently dilate the lung from day to day. To effect theinitial entrance of air, a notched tube such as is shown in Fig. 6 isemployed, the valve being omitted, however, in said figure, to moreclearly disclose the notch which is indicated by the numeral 12 and isformed in the lower surface of the outlet end of the tube, so as toadmit air into the tube behind the valve.

in practice, it is advisable to employ the notched tube immediatelyafter the operation, gradually decreasing the length of the notch day byday, then to utilize a tube of the type shown in Fig. at, in which thenotch is omitted, and finally, to employ the tube in Fig. 2, in whichthe outlet end face is perpendicular to the axis of the tube.

Referring, again, to the wing member 6 of the support A, it will be seenthat said member projects in a downward and outard curve directly infront of the outlet end of the tube, thus affording adequate protectiontherefor from interference on the part of the dressing and from thedischarge from the wound. The wing is also intended to neutralize themovement of the chest wall of the patient during respiration, and tothis end a bandage is passed around said wing and around the chest withsufiicient tightness to force the wing far enough inward to exert aneven pressure upon the chest wall. It has been considered unnecessary toillustrate this bandage, however, as well as the dressings and otherbandages ap- )llQCl. The base member of the support is likewise adaptedto flex under bandage pressure, to conform to the shape of the chestwall.

Owing to the pivotal mounting of the tube. it will be appreciated thatthe latter can readily accommodate itself to incisions of variousinclinations, and when in position it cannot turn or be otherwisedisplaced. This is a matter of considerable importance, since suchturning movement, if possible, might irritate the tissues of the woundand cause the same to become infected. A similar result is also avoidedby preventing the matter discharged through the tube from coming intocontact with the tissues, and by wrapping the tube with sev eralthicknesses of gauze or other suitable material, saturated with a 5%solution of iodoform, or otherwise appropriately medicated. Thiswrapping, which is indicated in dotted lines in Fig. 2, serves toprevent the entrance of air around the outer surface of the drainagetube into the pleural cavity, as well as to keep the wound sterile. Italso has the effect of preventing the discharge from being sucked backinto the pleural cavity, thereby avoiding reinfection. Moreover, theconstruction of the device as a whole is such that it can be readilysterilized without injury to any of the parts thereof. It may, finally,be stated that the valve may be constructed of foil, or of any otherlight and flexible waterproof material, rather than of oiled silk, ifconsidered desirable, and that owing to the positive attachment of thedrainage tube to the shield, a very short length of tube may be made useof, thereby completely avoiding protrusion of the inlet end of the tubeinto the pleural cavity. In actual practice, the length of the tube issuch that its working portion is exactly equal to the combined thicknessof the chest wall of the patient and the wrapping of medicated gauze.

\Vhat is claimed is:

l. A surgical drainage device comprising a drainage tube having one endthereof adapted for reception in a wound, and asupport to which saidtube is pivoted, to accommodate itself to the trend of the incision.

2. A surgical drainage device comprising a drainage tube provided at oneend with a valve and having its other end adapted for reception in awound, and a support to which said tube is pivoted for movement relativeto said support in a vertical plane.

3. A surgical drainage device comprising a support formed with acentering opening, and a drainage tube pivoted to said support forangular adjustment with respect thereto, and having one of its endsprojecting through said opening and adapted for insertion in a wound.

l. A surgical device for drainage pleural effusions comprising a basemember, a drainage tube attached thereto, and a flexible wing connectedto said base and extending in front of said tube, to protect the same.

5. In a surgical device for draining pleural eflusions, a drainage tubeand a support therefor, said support being provided with a member uponwhich the tube is pivoted and by which it is held against turning, andwith an additional member extending in front of said tube for protectingthe same.

(3. In a surgical device for draining pleurai effusions, a resilientsupport comprising integrally-connected base and wing members, and adrainage tube pivoted to the base adjacent its outlet end and behindsaid wing, and provided with a valve at said end, said base being formedwith an opening through which said tube projects.

7. A surgical drainage tube having a valve pivoted to its outlet end andhaving a notch formed in said end to admit air behind the valve.

8. A surgical drainage tube having a valve pivoted to the upper surfaceof its outlet end, and having the face of said end extending rearwardlyand obliquely to its axis.

9. A surgical drainage tube having a valve pivoted to the upper surfaceof its outlet end, and having the face of said end rearwardly beveled,the lower surface of said end having a notch formed therein to admit airbehind the valve.

10. In a surgical device for draining pleural effusions, a supportcomprising a member adapted to flex under bandage pressure, to conformto the chest wall of the patient, and a flexible member connected to thefirst mentioned member for neutralizing the movement of said wall duringrespiration; in combination with a drainage tube attached to one of saidmembers.

11. A surgical drainage tube, having a movable valve of flexible sheetmaterial stitched to its outlet end for closing the same, the stitchespassing through said end at a point removed from the face thereof, topermit portions of said end to be cut away for varying the angle of saidface to the axis of said tube, to control the rapidity of the operationof said valve.

In testimony whereof I have hereunto set my hand in presence of twosubscribing Witnesses.

JOHN S. DEAN.

IVitnesses ED\VARD J. RIEDESEL, ALBERT DIECKMANN.

